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Spring 2019, Vol. 1
The 57th Oklahoma Legislature kicked off on February 4, 2019 with Governor Stitt's State of the State address. Also present were the cabinet secretaries. Lieutenant Governor Matt Pinnell gaveled in the joint session.
Legislators had a deadline of January 17 to file their bills, and a total of 2,834 bills were filed by the 149 members of the Oklahoma Senate and House of Representatives. Bills then had a deadline of February 28 to be heard in committee of their house of origin to advance to the floor. OHCA was tracking 193 bills at that time.
As of March 11, the OHCA Government Relations team continued to track 91 bills. These bills must be heard on the House or Senate floor by March 14 in order to keep moving through the process to possibly be signed into law.
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Bills to note include:
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HB 1278, by Rep. Lawson: Requires any reductions in planned Home- and Community-Based Services (HCBS) be applied prospectively and not changed retroactively, nor affect prior authorized services. It also requires a minimum of case management services for any new participant through the ADvantage Waiver program. This bill passed committee and the floor and now heads to the opposite chamber’s committee.
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HB 1277, by Rep. Lawson: Allows any Medicaid provider to bill OHCA for HCBS performed up to one year after the service was performed. This bill allows the provider to submit a subsequent claim up to one year after the original claim was denied. This bill passed committee and the floor and now heads to the opposite chamber’s committee.
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SB 605, by Sen. Greg McCortney: Creates "the Oklahoma Plan," which uses Insure Oklahoma to open Medicaid to more Oklahomans. This bill did not make it pass committee deadline but may come back later in the session through another vehicle.
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SB 456, by Senate President Pro Tempore Greg Treat: Makes the OHCA administrator a direct appointee of the governor and adds additional appointees to the board for the governor. This legislation passed committee, the floor in house of origin, the committee in the opposite chamber and is now headed for the House floor.
In May, the Legislature typically turns to the state budget. OHCA requested an increased budget for SFY 2020, notably, to increase provider reimbursement rates to 100 percent of Medicare. This would apply to almost all provider groups. The OHCA acknowledges the difficulties providers have undertaken in the past years as tight budgets have been balanced by provider cuts.
After the March 14 deadline for bills to be heard on the floor in their house of origin, the next set of deadline weeks are in April. The Legislature must adjourn "sine die" no later than 5 p.m. on May 31, 2019.
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Spring 2019 SoonerCare Provider Training Workshops will be held at five locations statewide, beginning April 30.
Scheduled trainings will cover the Insure Oklahoma program, SoonerCare referrals, patient-centered medical homes (PCMHs), provider enrollment and contracting, claims resolution, and promoting literacy in the well-child visit through the Reach Out and Read program.
The OHCA encourages providers and their staff to attend a workshop near them:
- April 30 – Lawton
- May 9 – Durant
- May 15 – Guymon
- May 22-23 – OKC
- May 29-30 – Tulsa
Please visit the OHCA Training page for specific times and locations.
Registration, complete class descriptions, as well as specific time and location information will be available beginning April 1, 2019.
We look forward to seeing you!
Don’t miss our Web Alerts! *Sign up to be notified about new SoonerCare training opportunities!
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Did you know?
SoonerCare education specialists are available for one-on-one and group training for providers and health-related community workgroups and coalitions.
Education specialists can answer questions about OHCA policy, programs and procedures as well as claim issues and navigating the secure SoonerCare Provider Portal.Training can be conducted on-site, through virtual visits, at the training facility in OKC or other appropriate venues.
To schedule training, please email SoonerCareEducation@okhca.org or call 405-522-7422. You may also fax your request to 405-530-3288. Please include the provider’s name, SoonerCare provider ID number, a return phone number and a contact name with your request.
For immediate claims or policy assistance, please contact the OHCA Provider Helpline at 800-522-0114.
Contracts for behavioral health practitioners under supervision expire May 31, 2019.
To avoid a disruption in service to our members, the OHCA encourages providers to renew early. The provider types listed above can log on to the secure OHCA Provider Portal to start renewing their contracts as early as March 18.
ATTENTION:
Please remember that all SoonerCare-contracted providers are responsible for keeping their provider file current.
Please make sure your email address(es), phone number(s) and location are up to date, so you can receive all pertinent OHCA communications.
If you have questions:
- Call toll free 800-522-0114, option 5 for Provider Contracts
(Hours: 8 a.m. – 5 p.m. Mon., Tues., Thurs., Fri., and 1 – 5 p.m. Wed.)
- Email us
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A valid Oklahoma mailing address is required for all SoonerCare members.
At their office visits, please encourage members to update any changes to their address through the SoonerCare Member Portal (www.mySoonerCare.org). The process takes less than five minutes and helps to prevent interruption of their benefits. You can even download or order our new flyer (one side in English, one side in Spanish) to distribute in your office.
Members can also update their contact information by calling the SoonerCare Helpline at 1-800-987-7767.
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The OHCA routinely reviews medical records in association with other business processes. The reviewers have noticed a lack of required information pertaining to vaccine administration and would like to remind providers of the required medical record documentation as per the CDC and ACIP recommendations.
All vaccines administered should be fully documented in the patient’s permanent medical record.
As per the requirements of the National Childhood Vaccine Injury Act and best practice, documentation should include the following:
- date of administration
- vaccine manufacturer
- vaccine lot number
- name and title of person who administered vaccine and address of facility where permanent record will reside
- vaccine information statement (VIS)
- date on VIS
- date provided to patient or parent/guardian
- vaccine type (ACIP abbreviation)
- route
- dosage (volume)
- site
- document vaccine refusal
Please contact the OHCA Provider Helpline at 1-800-522-0114 with any questions or concerns.
Related: OHCA Provider Letter 2019-01 serves to inform providers about policy regarding laboratory and diagnostic testing.
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The Focus Forward Oklahoma Program is working to address issues related to access and utilization of long-acting reversible contraceptives (LARC) through policy, education, and communication. Below are a few highlights to share with you.
Policy
SoonerCare policy on LARC has changed. Previous language placed restrictions on the number of devices that could be billed per member in a specific time frame. We have removed those restrictions. The new policy covers LARC devices, insertions and removals when medically appropriate and medically necessary. In addition, SoonerCare allows same-day billing for LARC devices/procedures codes along with office visit codes.
Education
Focus Forward Oklahoma continues to provide no-cost LARC training to Oklahoma providers, and we’ll offer training for clinical support staff this spring. Trainings kicked-off March 9, with additional sessions scheduled for April 13, May 11, and June 8, 2019. Training sessions take place in both Oklahoma City and Tulsa. For more information, go to www.focusforwardok.org; to register go to www.okhca.org/LARCTraining.
Communication
Finally, our program website provides information on a variety of helpful topics: 1) unintended and teen pregnancy in Oklahoma, 2) LARC, 3) training opportunities and 4) resources throughout the state. Be sure to check us out!
Have questions? Contact us at focusforwardok@okhca.org.
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The U.S. Food and Drug Administration (FDA) recently issued safety alerts addressing newly identified concerns for medications across multiple classes. The following table summarizes the recommendations.
For a hyperlinked version, please click here.
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SoonerCare has recently partnered with Arine, a health care technology company, to provide comprehensive medication management to select SoonerCare patients. The Arine program uses data from SoonerCare and information collected directly from patients via a secure online web application to predict, prevent and address potential consequences related to medication mismanagement.
Eligible SoonerCare patients will receive a comprehensive medication review via telephone, as well as targeted counseling and education on medication and disease management where and when needed.
Patients will be provided digital and mailed versions of their own personalized care plans and a comprehensive medication list. Arine will follow up with providers and their offices for any issues identified with the patient and their health.
Providers can refer SoonerCare members to the Arine program by contacting Arine directly at 1-833-ArineRx (1-833-274-6379) or emailing info@arine.io.
For more information, please visit www.arine.io.
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Effective April 29, 2019, opioid morphine milligram equivalent (MME) daily totals greater than or equal to 180 will require prior authorization (PA) with patient-specific, clinically significant reasoning why the member requires 180 MME per day or more (limit applies to both short-acting and long-acting formulations).
Providers can access a patient’s MME totals by consulting the Oklahoma Prescription Monitoring Program (PMP) Aware system. The PMP Aware system may contain additional opioid claims not reimbursed by SoonerCare.
This is the second phase of an MME limit that is expected to be completed by July:
Providers are encouraged to begin tapering (where appropriate) those members who exceed the 100 MME threshold.
OHCA encourages providers to access the PMP site and begin tapering (where appropriate) those members who exceed the 100 MME threshold.
Beginning July 2019, a claim will process without a PA if the member’s total daily MME is not greater than or equal to 100 (current opioid PA criteria and tier structure rules will continue to apply). If the member requires daily MME totals of 100 or more, then the provider can submit an MME override request via form PHARM-111, available on the SoonerCare website (http://www.okhca.org/rxforms).
Please note: Medications provided for medication-assisted treatment (MAT) will be exempt from this policy.
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Life can be “breathtakingly beautiful,” but it most certainly does not always feel that way. Human life is filled with all kinds of ups and downs. Each person will eventually deal with some degree of disappointment, worry, failure, even loss and trauma. In facing difficult situations, developing effective ways to deal with, keep going and rise above them is vital for our health.
This is why healthy coping is such an important and necessary skill and behavior. The primary care provider (PCP) can often be the initial or only contact people make while experiencing many stressors. Therefore, identifying appropriate behavioral health services and referrals is essential.
In working to develop healthy coping skills, providers, caregivers and/or therapists can collaborate with their patients. They can work together to create a list and discuss healthy coping skills that the patient can utilize when navigating some of life’s difficult experiences.
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Some examples of healthy coping:
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Relaxing – Take a nap, practice deep breathing, meditate
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Practicing self-care – Take a long bath or get a massage
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Exercise – Walk, run, work out, practice yoga
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Doing an activity – Work in a garden, play games, work on puzzles, attend church, watch a movie, listen to music, read, dance
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Creating something – Journal, write letters, write poetry, make art, take pictures
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Talk about it – Talk with someone at school or work, participate in individual or group counseling, attend support organization meetings
- Spending time with family or friends
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There are many online resources for creating coping activity and skill lists. Two examples are:
Behavioral Health Referrals
Providers can access the SoonerCare Behavioral Health Provider Directory online or call 1-800-652-2010 for assistance.
“Life is not what it’s supposed to be. It is what it is. The way you cope with it is what makes the difference." – Virginia Satir
Additional Resources
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Dr. Courtney Barrett, OHCA Dentist
April is Oral Cancer Awareness Month
According to Oral Cancer Foundation, one person every hour of the day will die from complications of oral cancer. OHCA encourages our providers to increase oral cancer awareness by speaking with patients about the risk factors for oral cancer, as well as the importance of early detection and prevention.
Though preventable and not as common as other cancers, oral cancer is particularly dangerous because in its early stages it may go undetected by the patient and can progress without pain or symptoms. The higher death rate associated with oral cancer is often as a result of the cancer being diagnosed late in its development. Oral cancer is frequently found after the cancer has metastasized to another location, most likely the lymph nodes of the neck. The survival rate for a localized diagnosis is more than twice as high as a metastasized cancer diagnosis, hence the importance of early detection. Patients who survive a first encounter with oral cancer have a higher risk of developing a second cancer – this increased risk factor can last for five to 10 years after the first occurrence.
Tobacco is single biggest risk factor for oral cancer and is responsible for most resulting deaths. The synergistic effect of tobacco usage and excessive alcohol consumption are additional leading risk factors for oral cancer. Those at an especially high risk of developing oral cancer are men over age 50 who are heavy drinkers and smokers. Chewing betel quid, excessive sun exposure, and consuming a poor diet may also contribute to the chances of developing oral cancer.
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The leading cause of oropharyngeal cancer is human papillomavirus (HPV). HPV is the most common sexually transmitted disease in the United States. There are more than 100 strains of HPV, however, only nine are associated with cancers, and only HPV-16 is strongly associated with oropharyngeal cancer.
Oral sex has been identified as the primary mechanism of oral colonization of HPV-16 and is related to the increasing incidence of mouth cancer in younger, non-smoking patients. There is a lower incidence of death with HPV-positive oropharyngeal cancers, though they typically develop in the throat at the base of the tongue and in the folds of the tonsils making them difficult to detect.
It is recommended that adolescents get the HPV vaccine at age 11 or 12, regardless of whether or not they are sexually active. The HPV vaccine is most effective when given before age 13, but vaccination may be provided up to age 26. SoonerCare covers the HPV vaccine under guidelines established by the Advisory Committee on Immunization Practices (ACIP) for children and adults.
Patients should be reminded to see their dentist for any sore, irritation, discoloration, erosion, lump or thickening of tissue which does not resolve within a two-week period. Any change in the way teeth fit together, difficulty chewing, speaking, swallowing, numbness, or hoarseness lasting longer than two weeks should be considered suspect and worthy of further examination or referral.
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Providers can get involved by educating patients and their families about oral cancer – discuss the risks and promote prevention:
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Host an oral cancer screening event, promote oral cancer awareness in your office and on your website.
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Refer patients to their dentist for regular exams and oral cancer screenings, as early diagnosis is key to treating oral cancer.
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Encourage patients to visit their primary care provider for HPV vaccinations; those without a PCP may contact the local health department.
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Encourage patients to limit alcohol and avoid smoking and tobacco products.
The Oklahoma Tobacco Helpline (1-800-Quit-Now) is a free service available 24/7 that provides support for those wanting to quit tobacco habits. In addition, SoonerCare members have a tobacco cessation counseling benefit that can be utilized for direct care from medical and dental providers. With your support we can continue to decrease the incidence of oral cancer.
For more information about oral cancer, its diagnosis and treatment, visit the Oral Cancer Foundation website.
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On March 5, 2019, OHCA held its bimonthly Tribal Consultation. OHCA hosts Tribal Consultation the first Tuesday of every odd month at 11 a.m. This is an opportunity for tribal governments and health care systems to hear possible OHCA future rule and waiver changes.
A topic of discussion this session involved therapeutic foster care revisions brought forward from the Department of Human Services (DHS) and the Oklahoma Office of Juvenile Affairs (OJA). Many tribal governments in the state of Oklahoma operate their own foster care programs, but there is currently no section of rules for tribal foster care only.
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OHCA Provider Helpline: 800-522-0114
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Insure Oklahoma (IO) is a great program. The Employer-Sponsored Insurance (ESI) plan helps businesses provide their eligible employees with affordable health care; the Individual Plan covers eligible Oklahomans who do not qualify for ESI, are temporarily unemployed, or are working disabled. We want everyone to know about IO, and our new outreach team is helping to accomplish that!
IO team members are traveling the state to educate communities and employers about the benefits of the program. If you would like us to set aside time to talk to you, please let us know. Email your request to IOoutreach@okhca.org.
We look forward to working with you!
Pictured: Insure Oklahoma Outreach Specialists (left to right) Nicole Paschall, Regena Carlson and Angelica Lopez
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How does a business qualify for the Insure Oklahoma Employer-Sponsored Insurance plan?
- The employer must have an operating location in Oklahoma.
- The employer can employ no more than 250 employees at a for-profit business. A nonprofit employer may employ up to 500 employees.
- The employer must be enrolled, or in the process of enrolling in, a qualified health plan.
Please visit Insure Oklahoma online for more information.
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Hundreds of smokeless tobacco users across Oklahoma took the pledge to stop dipping during “Through With Chew Week,” February 18-22, 2019. For many, it was a momentous start to a tobacco-free life. As a health care professional, discussing this event with your patients could serve as an icebreaker, helping them open up about their own tobacco use.
Many tobacco users turn to dipping because they perceive it as a safer alternative to smoking. The truth? An average, 30-minute dipping session delivers as much nicotine as four cigarettes. Smokeless tobacco can also cause cancers of the mouth, throat, cheek and gums, and contributes to an increased risk of heart attack and stroke.
Share these serious risks with your patients, and encourage them to seek help from the Oklahoma Tobacco Helpline. The Helpline offers FREE support including text and email messages, phone and web coaching and a two-week supply of patches, gum or lozenges for registered participants.
To promote the Helpline in your office, free materials are available at OKhelpline.com.
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Information contained within is subject to change. Be sure to check OHCA Provider Letters, Global Messages and Web Alerts at www.okhca.org for the most up-to-date information.
March 13
Drug Utilization Review (DUR) Board Meeting
March 14
Medical Advisory Committee (MAC) Meeting
March 21
OHCA Board Meeting
*All meetings take place at OHCA offices (4345 N. Lincoln Blvd., Oklahoma City), in the Ed McFall Boardroom, unless otherwise noted.
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